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Obama’s health-care triumph? What a Pyrrhic victory

Yes, President Barack Obama's 2010 health-care reform bill was a real watershed for the US, I enthusiastically told the lady from BBC Radio the day after the bill squeaked through the House. History will compare it to LBJ's historic Civil Rights Act of 1964. Or even his creation of Medicare the following year. A couple of minutes into the live interview, though, I realised that I was in danger of getting carried away. I switched mood and said that it will be at least a decade before we know what the effects of the bill will actually be.

You really have to have lived in a country that has a pretty good national health-care system, such as Britain's (the "socialised medicine" so dreaded by Americans), or a superb one, such as France's (also financed by the government, but largely through non-profit-making insurance companies), before you fully understand what it is like to live in a country that has such a truly dire health system as America does.

Here, you have to pay almost twice as much as in Britain for medical treatment, yet must expect to die a year earlier. The French, still so patronised here, live three years longer than the average American. So, now that health insurance, under Obama's bill, will cover 32 million more Americans (note, a further 24 million will still be left with no medical insurance what­soever in 2019), is this legislation the big breakthrough for US health care?

Profit of doom

“Now let [the Republicans] tell a child with a pre-existing condition, 'We don't think you should be covered,'" exulted David Axelrod, Obama's very own Svengali, after the vote on 21 March. What Axelrod failed to add was that insurance companies still won't have to cover that kid with a pre-existing condition until 2014 - by which time, the Republicans plan, the GOP will have romped back to controlling Congress, from where they will swiftly kill off that kind of large-scale reform.

I, too, have a "pre-existing condition" - an artificial heart valve that has ticked away happily for more than two decades, but which makes me uninsurable here. Profit-making health insurance companies, after all, only want to insure fully fit and healthy young people. The number of health-care lobbying organisations in DC grew from 398 to 1,541 during Obama's first year in office. The Republicans and their lobbyist chums are already frothing at the mouth to prevent other major reforms, most of which are not due to come into effect for four or nine years anyway, from seeing the light of day.

That is the fundamental weakness of the reforms: they all still revolve around the profit-making insurance companies, which will forever be devoted to keeping down costs and creating huge wealth for themselves. And they will do that by denying patients treatment.

If you think I am back to Obama-bashing again, I recommend an edition of BusinessWeek - not known for being a friend of the poor and downtrodden - from last August. "The health insurers have already won", its cover headline pronounced. "How UnitedHealth and rival carriers, manoeuvring behind the scenes in Washington, shaped health-care reform for their own benefit."

It went on to describe, to take just one example, how the former senator Tom Daschle - leader of the Senate Democrats from 1994-2004 and Obama's choice as health secretary until a tax scandal was unearthed - now advises UnitedHealth, despite having publicly advocated a government-run health system.

Herein lies the problem: between 2000 and 2007, the cost of health insurance in the US went up by 100 per cent. Doctors, justifiably terrified of litigation over wrong diagnoses, will send you for MRI and PET scans if you turn up with so much as an ingrowing toenail - just as they will wearily write prescriptions for useless but hugely expensive medications advertised ceaselessly on television.

The already ludicrous costs of US health care will continue to soar - meaning, inevitably, that the premiums charged by profit-hungry insurance companies will follow suit. One of the pledges that got Obama into the White House (that he would reduce the average family's health premiums by $2,500 per year) is now as doomed as his promise to shut down Guantanamo by the end of last year.

Hasty applause

Those who congratulate him for pushing the bill through without a single Republican vote are sadly mistaken, too, because the political costs will be enormous. LBJ managed to rustle up nearly half the House Republicans to vote for Medicare. By contrast, Obama made 92 direct interventions with House Democrats and, to snatch the crucial eight additional Democratic votes he needed, agreed at the last minute to ban government funding of abortion.

So much for the dreamy post-partisanship he also promised to bring Washington. Instead, he antagonised part of the Democratic base with his frantic abortion deal and, in effect, declared war for ever on the Republicans. Hell hath no fury like a scorned Republican, and the midterm elections in November are certain to be an electoral bloodbath.

What few in Europe understand is that, far from being grateful to Obama, even Americans deprived of decent health care - brainwashed by PR that first dreamed up the horror term "socialised medicine" in 1947 to combat Harry Truman's attempts at reform, and woefully ignorant of much better and less expensive health systems elsewhere - are not supporting his efforts. A CNN poll the day after the vote showed 59 per cent against the reforms and only 39 per cent for them.

I hope I'm wrong - I would rather like some insurance myself, after all - but the triumphalism, at best, is premature.

Andrew Stephen was appointed US Editor of the New Statesman in 2001, having been its Washington correspondent and weekly columnist since 1998. He is a regular contributor to BBC news programs and to The Sunday Times Magazine. He has also written for a variety of US newspapers including The New York Times Op-Ed pages. He came to the US in 1989 to be Washington Bureau Chief of The Observer and in 1992 was made Foreign Correspondent of the Year by the American Overseas Press Club for his coverage.